Comprehensive Summary
In their article, Warren et al. (2020) compared the effectiveness and palatability of three treatments for epigastric pain: antacid alone, antacid with 2% lidocaine solution, and antacid with 2% viscous lidocaine gel. The primary outcome was the change in pain scores at 30 minutes, with secondary outcomes being medicine palatability and change in pain score at 60 minutes. The double-blind trial enrolled 89 ED patients, with roughly equal allocation across the three treatment arms. Antacid monotherapy produced the largest reduction in pain score at 30 minutes, though the differences among medications were not statistically significant. However, antacid monotherapy was significantly found to be the most palatable and acceptable of the three medications. Given the similar analgesic benefit across medicine groups but the shown preference for antacid monotherapy, authors recommend discontinuing routine lidocaine use in favor of antacid alone for ED management of epigastric pain.
Outcomes and Implications
Current treatments for epigastric pain in the ED involve either an antiacid monotherapy or an antiacid combination with lidocaine. While both regiments can help reduce discomfort in individuals experiencing epigastric pain, some individuals report lidocaine causing oral numbness along with dizziness and tiredness. Due to the potential for adverse events, researchers in the present study highlight the lack of a significant difference in effectiveness between antacid monotherapy and a combination with lidocaine, and point towards antacid monotherapy as being a more beneficial treatment option for individuals experiencing epigastric pain. Antacid monotherapy provides comparable pain relief while being better tolerated by patients, and avoids unnecessary anesthetic exposure. For ED clinicians, eliminating lidocaine can streamline care, reduce side effects, while still achieving the desired symptom control.